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van de Leur RR, van Sleuwen MTGM, Zwetsloot PPM, van der Harst P, Doevendans PA, Hassink RJ, van Es R. Automatic triage of twelve-lead electrocardiograms using deep convolutional neural networks: a first implementation study. Eur Heart J Digit Health 2024; 5:89-96. [PMID: 38264701 PMCID: PMC10802816 DOI: 10.1093/ehjdh/ztad070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/10/2023] [Accepted: 11/07/2023] [Indexed: 01/25/2024]
Abstract
Aims Expert knowledge to correctly interpret electrocardiograms (ECGs) is not always readily available. An artificial intelligence (AI)-based triage algorithm (DELTAnet), able to support physicians in ECG prioritization, could help reduce current logistic burden of overreading ECGs and improve time to treatment for acute and life-threatening disorders. However, the effect of clinical implementation of such AI algorithms is rarely investigated. Methods and results Adult patients at non-cardiology departments who underwent ECG testing as a part of routine clinical care were included in this prospective cohort study. DELTAnet was used to classify 12-lead ECGs into one of the following triage classes: normal, abnormal not acute, subacute, and acute. Performance was compared with triage classes based on the final clinical diagnosis. Moreover, the associations between predicted classes and clinical outcomes were investigated. A total of 1061 patients and ECGs were included. Performance was good with a mean concordance statistic of 0.96 (95% confidence interval 0.95-0.97) when comparing DELTAnet with the clinical triage classes. Moreover, zero ECGs that required a change in policy or referral to the cardiologist were missed and there was a limited number of cases predicted as acute that did not require follow-up (2.6%). Conclusion This study is the first to prospectively investigate the impact of clinical implementation of an ECG-based AI triage algorithm. It shows that DELTAnet is efficacious and safe to be used in clinical practice for triage of 12-lead ECGs in non-cardiology hospital departments.
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Affiliation(s)
- Rutger R van de Leur
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Meike T G M van Sleuwen
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Peter-Paul M Zwetsloot
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
- Central Military Hospital, Utrecht, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - René van Es
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
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Scutelnic A, van de Munckhof A, Krzywicka K, van Kammen MS, Lindgren E, Cordonnier C, Kleinig TJ, Field TS, Poli S, Lemmens R, Middeldorp S, Aaron S, Borhani-Haghighi A, Arauz A, Kremer Hovinga JA, Günther A, Putaala J, Wasay M, Conforto AB, de Sousa DA, Jood K, Tatlisumak T, Ferro JM, Coutinho JM, Arnold M, Heldner MR. Sex differences in cerebral venous sinus thrombosis after adenoviral vaccination against COVID-19. Eur Stroke J 2023; 8:1001-1010. [PMID: 37434312 PMCID: PMC10345391 DOI: 10.1177/23969873231185213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/13/2023] [Indexed: 07/13/2023] Open
Abstract
INTRODUCTION Cerebral venous sinus thrombosis associated with vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) is a severe disease with high mortality. There are few data on sex differences in CVST-VITT. The aim of our study was to investigate the differences in presentation, treatment, clinical course, complications, and outcome of CVST-VITT between women and men. PATIENTS AND METHODS We used data from an ongoing international registry on CVST-VITT. VITT was diagnosed according to the Pavord criteria. We compared the characteristics of CVST-VITT in women and men. RESULTS Of 133 patients with possible, probable, or definite CVST-VITT, 102 (77%) were women. Women were slightly younger [median age 42 (IQR 28-54) vs 45 (28-56)], presented more often with coma (26% vs 10%) and had a lower platelet count at presentation [median (IQR) 50x109/L (28-79) vs 68 (30-125)] than men. The nadir platelet count was lower in women [median (IQR) 34 (19-62) vs 53 (20-92)]. More women received endovascular treatment than men (15% vs 6%). Rates of treatment with intravenous immunoglobulins were similar (63% vs 66%), as were new venous thromboembolic events (14% vs 14%) and major bleeding complications (30% vs 20%). Rates of good functional outcome (modified Rankin Scale 0-2, 42% vs 45%) and in-hospital death (39% vs 41%) did not differ. DISCUSSION AND CONCLUSIONS Three quarters of CVST-VITT patients in this study were women. Women were more severely affected at presentation, but clinical course and outcome did not differ between women and men. VITT-specific treatments were overall similar, but more women received endovascular treatment.
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Affiliation(s)
- Adrian Scutelnic
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anita van de Munckhof
- Department of Neurology, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | - Katarzyna Krzywicka
- Department of Neurology, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | - Mayte Sánchez van Kammen
- Department of Neurology, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | - Erik Lindgren
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Timothy J Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, Australia
| | - Thalia S Field
- Devision of Neurology, Vancouver Stroke Program, University of British Columbia, Vancouver, Canada
| | - Sven Poli
- Department of Neurology & Stroke, University Hospital Tuebingen, Eberhard-Karls University, Tuebingen, Germany
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Saskia Middeldorp
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sanjith Aaron
- Department of Neurosciences, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | | | - Antonio Arauz
- Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suárez, Mexico City
| | - Johanna A Kremer Hovinga
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Albrecht Günther
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | | | - Diana Aguiar de Sousa
- Lisbon Central University Hospital and Faculdade de Medicina da Universidade de Lisboa, Portugal
| | - Katarina Jood
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Turgut Tatlisumak
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - José M Ferro
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Oostra DL, Nieuwboer MS, Melis RJF, Remers TEP, Olde Rikkert MGM, Perry M. DementiaNet facilitates a sustainable transition toward integrated primary dementia care: A long-term evaluation. Alzheimers Dement 2023; 19:5498-5505. [PMID: 37218358 DOI: 10.1002/alz.13154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Care integration is a promising strategy to achieve sustainable health-care systems. With DementiaNet, a 2-year program, we facilitated collaboration between primary health-care professionals. We studied changes in primary dementia care integration during and after DementiaNet participation. METHODS A longitudinal follow-up study was performed. Networks started between 2015 and 2020; follow-up ended in 2021. Quantitative and quantitative data were collected annually to assess quality of care, network collaboration, and number of crisis admissions. Growth modeling was used to identify changes over time. RESULTS Thirty-five primary care networks participated. Network collaboration and quality of care of newly formed networks increased significantly in the first 2 years (respectively, 0.35/year, P < .001; 0.29/year, P < .001) and thereafter stabilized. CONCLUSION Primary care networks improved their collaboration and quality of care during DementiaNet participation, which persisted after the program ended. This indicates that DementiaNet facilitated a sustainable transition toward integrated primary dementia care.
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Affiliation(s)
- Dorien L Oostra
- Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Radboud university medical center, Nijmegen, The Netherlands
| | - Minke S Nieuwboer
- Radboudumc Alzheimer Center, Radboud university medical center, Nijmegen, The Netherlands
- HAN University of Applied Sciences, Academy of Health and Vitality, Nijmegen, The Netherlands
| | - René J F Melis
- Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Radboud university medical center, Nijmegen, The Netherlands
| | - Toine E P Remers
- Radboud university medical center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands
| | - Marcel G M Olde Rikkert
- Radboudumc Alzheimer Center, Radboud university medical center, Nijmegen, The Netherlands
- Department of Geriatric Medicine, Radboud university medical center, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
| | - Marieke Perry
- Radboudumc Alzheimer Center, Radboud university medical center, Nijmegen, The Netherlands
- Department of Geriatric Medicine, Radboud university medical center, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
- Department of Primary and Community Care, Radboud university medical center, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
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van Eijk J, Rutten JJS, Hertogh CMPM, Smalbrugge M, van Buul LW. Observation of urinary tract infection signs and symptoms in nursing home residents with impaired awareness or ability to communicate signs and symptoms: The development of supportive tools. Int J Older People Nurs 2023; 18:e12560. [PMID: 37563799 DOI: 10.1111/opn.12560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/24/2023] [Accepted: 07/08/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Antibiotics are often inappropriately prescribed for urinary tract infections (UTIs) in nursing home (NH) residents. Research emphasises the importance of prescribing antibiotics only if there are UTI-related signs and symptoms (S&S). However, for many NH residents it is challenging to find out whether such S&S are present, for example due to cognitive disorders. OBJECTIVES To provide insight into the assessment of UTI-related S&S in NH residents with impaired awareness or ability to communicate S&S, and to develop supportive tools for the observation of UTI-related S&S in this subgroup of NH residents, by nursing staff. METHODS We performed a practice-based study using mixed methods. Data of 295 cases of suspected UTI were analysed to determine how often UTI-related S&S were 'not assessed/non-assessable' in residents with and without dementia. Barriers and facilitators in observing UTI-related S&S in NH residents with impaired awareness or ability to communicate S&S were derived from interviews and focus groups with nursing staff. Literature review, focus group data, additional telephone interviews and questionnaires with nursing staff were used in a step-by-step process, including pilot testing, to develop supportive tools for the observation of UTI-related S&S. RESULTS UTI-related S&S were assessable in the majority of NH residents with dementia. The proportion 'not assessed/non-assessable' S&S in residents with dementia increased with increasing severity of dementia. In residents with very severe dementia, up to 58% of the S&S were 'not assessed/non-assessable'. Knowing the resident, working methodologically, and being sufficiently skilled to interpret observations in residents facilitate the assessment of UTI-related S&S. Insights acquired during the different study elements resulted in the development of an observation checklist and a 24-h observation tool. CONCLUSIONS The more NH residents have impaired awareness of ability to communicate S&S, the more difficult it seems to be to assess UTI-related S&S. The observation checklist and 24-h observation tool developed in the current study may support nursing staff in their observation of UTI-related S&S in this group of NH residents.
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Affiliation(s)
- Jorna van Eijk
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Jeanine J S Rutten
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Martin Smalbrugge
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Laura W van Buul
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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de Lange A, Alsem MW, Haspels HN, van Karnebeek CDM, van Woensel JBM, Etten-Jamaludin FS, Maaskant JM. Hospital-to-home transitions for children with medical complexity: part 1, a systematic review of reported outcomes. Eur J Pediatr 2023; 182:3805-3831. [PMID: 37318656 PMCID: PMC10570194 DOI: 10.1007/s00431-023-05050-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/19/2023] [Accepted: 05/31/2023] [Indexed: 06/16/2023]
Abstract
Outcome selection to evaluate interventions to support a successful transition from hospital to home of children with medical complexity (CMC) may be difficult due to the variety in available outcomes. To support researchers in outcome selection, this systematic review aimed to summarize and categorize outcomes currently reported in publications evaluating the effectiveness of hospital-to-home transitional care interventions for CMC. We searched the following databases: Medline, Embase, Cochrane library, CINAHL, PsychInfo, and Web of Science for studies published between 1 January 2010 and 15 March 2023. Two reviewers independently screened the articles and extracted the data with a focus on the outcomes. Our research group extensively discussed the outcome list to identify those with similar definitions, wording or meaning. Consensus meetings were organized to discuss disagreements, and to summarize and categorize the data. We identified 50 studies that reported in total 172 outcomes. Consensus was reached on 25 unique outcomes that were assigned to six outcome domains: mortality and survival, physical health, life impact (the impact on functioning, quality of life, delivery of care and personal circumstances), resource use, adverse events, and others. Most frequently studied outcomes reflected life impact and resource use. Apart from the heterogeneity in outcomes, we also found heterogeneity in designs, data sources, and measurement tools used to evaluate the outcomes. Conclusion: This systematic review provides a categorized overview of outcomes that may be used to evaluate interventions to improve hospital-to-home transition for CMC. The results can be used in the development of a core outcome set transitional care for CMC.
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Affiliation(s)
- Annemieke de Lange
- Department of Pediatrics, Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, the Netherlands
| | - Mattijs W Alsem
- Department of Rehabilitation, Amsterdam UMC location University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Heleen N Haspels
- Department of Pediatrics, Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, the Netherlands
- Department of Pediatric and Neonatal Intensive Care, Division of Pediatric Intensive Care, ErasmusMC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Clara D M van Karnebeek
- Department of Pediatrics and Human Genetics, Emma Center for Personalized Medicine, Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Amsterdam Reproduction and Development, Meibergdreef 9, Amsterdam, the Netherlands
| | - Job B M van Woensel
- Department of Pediatrics, Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, the Netherlands
| | - Faridi S Etten-Jamaludin
- Medical Library, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jolanda M Maaskant
- Department of Pediatrics, Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, the Netherlands.
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Szilagyi IA, Waarsing JH, van Meurs JBJ, Bierma-Zeinstra SMA, Schiphof D. A systematic review of the sex differences in risk factors for knee osteoarthritis. Rheumatology (Oxford) 2023; 62:2037-2047. [PMID: 36495186 PMCID: PMC10234207 DOI: 10.1093/rheumatology/keac688] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 12/01/2022] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVES Previous systematic reviews focused on the evidence of common risk factors for knee OA (KOA); however, the effect and strength of association between risk factors and KOA might be different between the two sexes. The aim of the present systematic review was to determine the current evidence on sex differences in the association between risk factors and KOA and their prevalence. METHODS We searched the following electronic bibliographic databases: MEDLINE (PubMed), EMBASE and Web of Science. A methodological quality assessment was conducted independently by two researchers according to an adapted version of the standardized set of criteria known as the Newcastle-Ottawa Quality Assessment Scale (NOS). The NOS, a star system, was converted to three categories of quality. RESULTS In total, 27 studies reported sex-specific risk estimates on several risk factors for KOA. Out of the 22 longitudinal cohort studies (except one nested case-control), 12 were of good quality and 10 were of fair quality. The five cross-sectional studies consisted of one of good, three of fair and one of poor quality. There was an indication of sex differences in risk factors leading to higher risk of KOA: high BMI, alcohol consumption, atherosclerosis and high vitamin E levels in women, and high physical activity, soft drink consumption and abdominal obesity in men. Knee injury, high blood pressure and low step rate seem to affect both women and men. CONCLUSION More good quality studies are needed to assess sex differences in risk factors for KOA, especially for symptomatic/clinical OA.
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Affiliation(s)
- Ingrid A Szilagyi
- Correspondence to: Ingrid A. Szilagyi, Department of General Practice, Erasmus MC, University Medical Center Rotterdam, PO Box 2400, Rotterdam 3000 CA, The Netherlands. E-mail:
| | - Jan H Waarsing
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Joyce B J van Meurs
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dieuwke Schiphof
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Geboers C, Candel MJJM, Chaloupka FJ, Nagelhout GE, de Vries H, van den Putte B, Shang C, Fong GT, Willemsen MC. Trends in Individualized Affordability of Factory-Made Cigarettes: Findings of the 2008-2020 International Tobacco Control Netherlands Surveys. Nicotine Tob Res 2023; 25:746-754. [PMID: 36410657 PMCID: PMC10032191 DOI: 10.1093/ntr/ntac259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/02/2022] [Accepted: 11/10/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Cigarette affordability, the price of tobacco relative to consumer income, is a key determinant of tobacco consumption. AIMS AND METHODS This study examined trends over 12 years in individualized factory-made cigarette affordability in the Netherlands, and whether these trends differed by sex, age, and education. Data from 10 waves (2008-2020) of the International Tobacco Control Netherlands Surveys were used to estimate individualized affordability, measured as the percentage of income required to buy 100 cigarette packs (Relative Income Price [RIP]), using self-reported prices and income. The higher the RIP, the less affordable cigarettes are. Generalized estimating equation regression models assessed trends in individualized affordability over time and by sex, age, and education. RESULTS Affordability decreased significantly between 2008 and 2020, with RIP increasing from 1.89% (2008) to 2.64% (2020) (p ≤ .001), except for 2008-2010, no significant year-on-year changes in affordability were found. Lower affordability was found among subgroups who have a lower income level: Females (vs. males), 18-24 and 25-39-year-olds (vs. 55 years and over) and low or moderate-educated individuals (vs. highly educated). Interactions between wave and education (p = .007) were found, but not with sex (p = .653) or age (p = .295). A decreasing linear trend in affordability was found for moderately (p = .041) and high-educated (p = .025), but not for low-educated individuals (p = .149). CONCLUSIONS Cigarettes in the Netherlands have become less affordable between 2008 and 2020, yet this was mostly because of the decrease in affordability between 2008 and 2010. There is a need for more significant increases in tax to further decrease affordability. IMPLICATIONS Our findings suggest that cigarettes have become less affordable in the Netherlands between 2008 and 2020. But, this appears to be the result of a steep decrease in affordability between 2008 and 2010. Affordability was lower among groups who have on average lower incomes (females, young adults, and low- and moderate-educated individuals), and differences in trends across education levels could be explained by per capita income changes. Our individualized measure indicated lower affordability than published aggregate affordability estimations. Future tax increases should be large enough to result in a lower affordability.
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Affiliation(s)
- Cloé Geboers
- Department of Health Promotion (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands
| | - Math J J M Candel
- Department of Methodology and Statistics (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Frank J Chaloupka
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Gera E Nagelhout
- Department of Health Promotion (CAPHRI), Maastricht University, Maastricht, The Netherlands
- IVO Research Institute, The Hague, The Netherlands
| | - Hein de Vries
- Department of Health Promotion (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Bas van den Putte
- Department of Communication (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
| | - Ce Shang
- Department of Internal Medicine, Ohio State University, Columbus, OH, USA
| | - Geoffrey T Fong
- Department of Psychology and School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Marc C Willemsen
- Department of Health Promotion (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands
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van den Heuvel LM, Woudstra AJ, van der Hout S, Jans S, Wiersma T, Dondorp W, Birnie E, Lakeman P, Henneman L, Plantinga M, van Langen IM. Primary care professionals' views on population-based expanded carrier screening: an online focus group study. Fam Pract 2023:cmad011. [PMID: 36722294 DOI: 10.1093/fampra/cmad011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Population-based expanded carrier screening (ECS) involves screening for multiple recessive diseases offered to all couples considering a pregnancy or during pregnancy. Previous research indicates that in some countries primary care professionals are perceived as suitable providers for ECS. However, little is known about their perspectives. We therefore aimed to explore primary care professionals' views on population-based ECS. METHODS Four online focus groups with 14 general practitioners (GPs) and 16 community midwives were conducted in the Netherlands. RESULTS Our findings highlight various perspectives on the desirability of population-based ECS. Participants agreed that ECS could enhance reproductive autonomy and thereby prevent suffering of the child and/or parents. However, they also raised several ethical, societal, and psychological concerns, including a tendency towards a perfect society, stigmatization, unequal access to screening and negative psychosocial consequences. Participants believed that provision of population-based ECS would be feasible if prerequisites regarding training and reimbursement for providers would be fulfilled. most GPs considered themselves less suitable or capable of providing ECS, in contrast to midwives who did consider themselves suitable. Nevertheless, participants believed that, if implemented, ECS should be offered in primary care or by public health services rather than as hospital-based specialized care, because they believed a primary care ECS offer increases access in terms of time and location. CONCLUSIONS While participants believed that an ECS offer would be feasible, they questioned its desirability and priority. Studies on the desirability and feasibility of population-based ECS offered in primary care or public health settings are needed.
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Affiliation(s)
- Lieke M van den Heuvel
- Department of Genetics, University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands
- Department of Human Genetics and Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Anke J Woudstra
- Department of Human Genetics and Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Sanne van der Hout
- Department of Health, Ethics & Society, Maastricht University Medical Centre/Maastricht University, Maastricht, The Netherlands
| | - Suze Jans
- Department of Child Health, TNO, Leiden, The Netherlands
| | - Tjerk Wiersma
- Dutch College of General Practitioners, Utrecht, The Netherlands
| | - Wybo Dondorp
- Department of Health, Ethics & Society, Maastricht University Medical Centre/Maastricht University, Maastricht, The Netherlands
| | - Erwin Birnie
- Department of Genetics, University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands
| | - Phillis Lakeman
- Department of Human Genetics and Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lidewij Henneman
- Department of Human Genetics and Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Mirjam Plantinga
- Department of Genetics, University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands
| | - Irene M van Langen
- Department of Genetics, University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands
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Emmert-Fees KMF, Capacci S, Sassi F, Mazzocchi M, Laxy M. Estimating the impact of nutrition and physical activity policies with quasi-experimental methods and simulation modelling: an integrative review of methods, challenges and synergies. Eur J Public Health 2022; 32:iv84-iv91. [PMID: 36444112 PMCID: PMC9706116 DOI: 10.1093/eurpub/ckac051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The promotion of healthy lifestyles has high priority on the global public health agenda. Evidence on the real-world (cost-)effectiveness of policies addressing nutrition and physical activity is needed. To estimate short-term policy impacts, quasi-experimental methods using observational data are useful, while simulation models can estimate long-term impacts. We review the methods, challenges and potential synergies of both approaches for the evaluation of nutrition and physical activity policies. METHODS We performed an integrative review applying purposive literature sampling techniques to synthesize original articles, systematic reviews and lessons learned from public international workshops conducted within the European Union Policy Evaluation Network. RESULTS We highlight data requirements for policy evaluations, discuss the distinct assumptions of instrumental variable, difference-in-difference, and regression discontinuity designs and describe the necessary robustness and falsification analyses to test them. Further, we summarize the specific assumptions of comparative risk assessment and Markov state-transition simulation models, including their extension to microsimulation. We describe the advantages and limitations of these modelling approaches and discuss future directions, such as the adequate consideration of heterogeneous policy responses. Finally, we highlight how quasi-experimental and simulation modelling methods can be integrated into an evidence cycle for policy evaluation. CONCLUSIONS Assumptions of quasi-experimental and simulation modelling methods in policy evaluations should be credible, rigorously tested and transparently communicated. Both approaches can be applied synergistically within a coherent framework to compare policy implementation scenarios and improve the estimation of nutrition and physical activity policy impacts, including their distribution across population sub-groups.
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Affiliation(s)
- Karl M F Emmert-Fees
- Correspondence: Karl M.F. Emmert-Fees, Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany, Tel: +49 89 3187-43709, e-mail:
| | - Sara Capacci
- Department of Statistical Sciences, University of Bologna, Bologna, Italy
| | - Franco Sassi
- Centre for Health Economics and Policy Innovation (CHEPI), Imperial College Business School, London, UK
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10
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Kelly L, Twohig C, Woods CB, Luszczynska A, Murrin C, Lien N, Meshkovska B, Kamphuis CBM, Poelman MP, Terragani L, Forberger S, Hebestreit A, Ahrens W, Harrington JM. Reaching consensus on definitions for food and physical activity policies: experience from the Policy Evaluation Network. Eur J Public Health 2022; 32:iv10-iv20. [PMID: 36444104 PMCID: PMC9706120 DOI: 10.1093/eurpub/ckac147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND An upsurge in policy evaluation research within public health sciences has led to multi-disciplinary research networks like the 'Policy Evaluation Network' (PEN). This multi-disciplinary collaboration highlighted the need for consensus on clear, common terminology and definitions to facilitate the multi-disciplinary research. This article outlines the development process of the PEN definitions glossary tool, with a focus on the key domains of policy design, implementation and outcomes as they apply to physical activity, sedentary behaviour and dietary behaviours. METHODS A project specific participatory process was undertaken, involving PEN researchers (n = 48) from seven European countries across various disciplinary backgrounds. All involved researchers were invited to identify and collate definitions that were commonly used in their research field. Terms and definitions were discussed and debated during three online workshops. Subsequently, the definitions were discussed and refined until consensus was reached. RESULTS Consensus definitions for 93 terms related to the evaluation of policy design, implementation and outcomes are provided. Consensus was reached on a range of terms where the terms were understood and used differently across represented disciplines (e.g. 'Outcome' and 'Impact'). A conceptual 'Inter-relations in policy-related concepts' diagram was developed to enable navigation through an online database with key terms. CONCLUSIONS The definitions resulting from this participatory process has supported PEN researchers and practitioners across disciplines to reach a shared understanding of different terms related to policy evaluation. Thus, providing a platform for avoiding conflicting use of the same terms in differing contexts over the course of the PEN work programme, facilitating clear and consistent communication, and allowing for clarity within collaborative multi-disciplinary projects and in public-facing messages.
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Affiliation(s)
- Liam Kelly
- Department of Physical Education and Sport Sciences, Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Cliona Twohig
- Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland
| | - Catherine B Woods
- Department of Physical Education and Sport Sciences, Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Aleksandra Luszczynska
- Department of Psychology in Wroclaw, CARE-BEH Center for Applied Research on Health Behaviour and Health, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Celine Murrin
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin, Ireland
| | - Nanna Lien
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Biljana Meshkovska
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Carlijn B M Kamphuis
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
| | - Maartje P Poelman
- Chair Group Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, The Netherlands
| | - Laura Terragani
- Department of Nutrition, Faculty of Health Sciences, Oslo Metropolitan University (OsloMet), Oslo, Norway
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Antje Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Janas M Harrington
- Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland
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11
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Hermanides J, Hong YT, Trivedi M, Outtrim J, Aigbirhio F, Nestor PJ, Guilfoyle M, Winzeck S, Newcombe VFJ, Das T, Correia MM, Carpenter KLH, Hutchinson PJA, Gupta AK, Fryer TD, Pickard JD, Menon DK, Coles JP. Metabolic derangements are associated with impaired glucose delivery following traumatic brain injury. Brain 2021; 144:3492-3504. [PMID: 34240124 PMCID: PMC8677561 DOI: 10.1093/brain/awab255] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 05/20/2021] [Accepted: 06/14/2021] [Indexed: 11/13/2022] Open
Abstract
Metabolic derangements following traumatic brain injury are poorly characterized. In this single-centre observational cohort study we combined 18F-FDG and multi-tracer oxygen-15 PET to comprehensively characterize the extent and spatial pattern of metabolic derangements. Twenty-six patients requiring sedation and ventilation with intracranial pressure monitoring following head injury within a Neurosciences Critical Care Unit, and 47 healthy volunteers were recruited. Eighteen volunteers were excluded for age over 60 years (n = 11), movement-related artefact (n = 3) or physiological instability during imaging (n = 4). We measured cerebral blood flow, blood volume, oxygen extraction fraction, and 18F-FDG transport into the brain (K1) and its phosphorylation (k3). We calculated oxygen metabolism, 18F-FDG influx rate constant (Ki), glucose metabolism and the oxygen/glucose metabolic ratio. Lesion core, penumbra and peri-penumbra, and normal-appearing brain, ischaemic brain volume and k3 hotspot regions were compared with plasma and microdialysis glucose in patients. Twenty-six head injury patients, median age 40 years (22 male, four female) underwent 34 combined 18F-FDG and oxygen-15 PET at early, intermediate, and late time points (within 24 h, Days 2-5, and Days 6-12 post-injury; n = 12, 8, and 14, respectively), and were compared with 20 volunteers, median age 43 years (15 male, five female) who underwent oxygen-15, and nine volunteers, median age 56 years (three male, six female) who underwent 18F-FDG PET. Higher plasma glucose was associated with higher microdialysate glucose. Blood flow and K1 were decreased in the vicinity of lesions, and closely related when blood flow was <25 ml/100 ml/min. Within normal-appearing brain, K1 was maintained despite lower blood flow than volunteers. Glucose utilization was globally reduced in comparison with volunteers (P < 0.001). k3 was variable; highest within lesions with some patients showing increases with blood flow <25 ml/100 ml/min, but falling steeply with blood flow lower than 12 ml/100 ml/min. k3 hotspots were found distant from lesions, with k3 increases associated with lower plasma glucose (Rho -0.33, P < 0.001) and microdialysis glucose (Rho -0.73, P = 0.02). k3 hotspots showed similar K1 and glucose metabolism to volunteers despite lower blood flow and oxygen metabolism (P < 0.001, both comparisons); oxygen extraction fraction increases consistent with ischaemia were uncommon. We show that glucose delivery was dependent on plasma glucose and cerebral blood flow. Overall glucose utilization was low, but regional increases were associated with reductions in glucose availability, blood flow and oxygen metabolism in the absence of ischaemia. Clinical management should optimize blood flow and glucose delivery and could explore the use of alternative energy substrates.
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Affiliation(s)
- Jeroen Hermanides
- University Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - Young T Hong
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Monica Trivedi
- University Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - Joanne Outtrim
- University Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - Franklin Aigbirhio
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Peter J Nestor
- Queensland Brain Institute, University of Queensland, Brisbane, Australia
| | - Matthew Guilfoyle
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Stefan Winzeck
- University Division of Anaesthesia, University of Cambridge, Cambridge, UK
- BioMedIA Group, Department of Computing, Imperial College, London, UK
| | | | - Tilak Das
- Department of Radiology, Addenbrooke’s Hospital, Cambridge, UK
| | - Marta M Correia
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Keri L H Carpenter
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Peter J A Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Arun K Gupta
- University Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - Tim D Fryer
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - John D Pickard
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - David K Menon
- University Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - Jonathan P Coles
- University Division of Anaesthesia, University of Cambridge, Cambridge, UK
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12
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Hoeben EM, Bernasco W, Suonperä Liebst L, van Baak C, Rosenkrantz Lindegaard M. Social distancing compliance: A video observational analysis. PLoS One 2021; 16:e0248221. [PMID: 33720951 PMCID: PMC7959357 DOI: 10.1371/journal.pone.0248221] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 02/18/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Virus epidemics may be mitigated if people comply with directives to stay at home and keep their distance from strangers in public. As such, there is a public health interest in social distancing compliance. The available evidence on distancing practices in public space is limited, however, by the lack of observational data. Here, we apply video observation as a method to examine to what extent members of the public comply with social distancing directives. DATA Closed Circuit Television (CCTV) footage of interactions in public was collected in inner-city Amsterdam, the Netherlands. From the footage, we observed instances of people violating the 1.5-meter distance directives in the weeks before, during, and after these directives were introduced to mitigate the COVID-19 pandemic. RESULTS We find that people complied with the 1.5-meter distance directives when these directives were first introduced, but that the level of compliance started to decline soon after. We also find that violation of the 1.5-meter distance directives is strongly associated with the number of people observed on the street and with non-compliance to stay-at-home directives, operationalized with large-scale aggregated location data from cell phones. All three measures correlate to a varying extent with temporal patterns in the transmission of the COVID-19 virus, temperature, COVID-19 related Google search queries, and media attention to the topic. CONCLUSION Compliance with 1.5 meter distance directives is short-lived and coincides with the number of people on the street and with compliance to stay-at-home directives. Potential implications of these findings are that keep- distance directives may work best in combination with stay-at-home directives and place-specific crowd-control strategies, and that the number of people on the street and community-wide mobility as captured with cell phone data offer easily measurable proxies for the extent to which people keep sufficient physical distance from others at specific times and locations.
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Affiliation(s)
- Evelien M. Hoeben
- Netherlands Institute for the Study of Crime and Law Enforcement (NSCR), Amsterdam, The Netherlands
| | - Wim Bernasco
- Netherlands Institute for the Study of Crime and Law Enforcement (NSCR), Amsterdam, The Netherlands
- Department of Spatial Economics, School of Business and Economics, VU University Amsterdam, Amsterdam, The Netherlands
| | | | - Carlijn van Baak
- Netherlands Institute for the Study of Crime and Law Enforcement (NSCR), Amsterdam, The Netherlands
| | - Marie Rosenkrantz Lindegaard
- Netherlands Institute for the Study of Crime and Law Enforcement (NSCR), Amsterdam, The Netherlands
- Department of Spatial Economics, School of Business and Economics, VU University Amsterdam, Amsterdam, The Netherlands
- Department of Sociology, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
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13
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Uil M, Hau CM, Ahdi M, Mills JD, Kers J, Saleem MA, Florquin S, Gerdes VEA, Nieuwland R, Roelofs JJTH. Cellular origin and microRNA profiles of circulating extracellular vesicles in different stages of diabetic nephropathy. Clin Kidney J 2021; 14:358-365. [PMID: 33564439 PMCID: PMC7857783 DOI: 10.1093/ckj/sfz145] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 09/13/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Diabetic nephropathy (DN) is a major complication of diabetes and the main cause of end-stage renal disease. Extracellular vesicles (EVs) are small cell-derived vesicles that can alter disease progression by microRNA (miRNA) transfer. METHODS In this study, we aimed to characterize the cellular origin and miRNA content of EVs in plasma samples of type 2 diabetes patients at various stages of DN. Type 2 diabetes patients were classified in three groups: normoalbuminuria, microalbuminuria and macroalbuminuria. The concentration and cellular origin of plasma EVs were measured by flow cytometry. A total of 752 EV miRNAs were profiled in 18 subjects and differentially expressed miRNAs were validated. RESULTS Diabetic patients with microalbuminuria and/or macroalbuminuria showed elevated concentrations of total EVs and EVs from endothelial cells, platelets, leucocytes and erythrocytes compared with diabetic controls. miR-99a-5p was upregulated in macroalbuminuric patients compared with normoalbuminuric and microalbuminuric patients. Transfection of miR-99a-5p in cultured human podocytes downregulated mammalian target of rapamycin (mTOR) protein expression and downregulated the podocyte injury marker vimentin. CONCLUSIONS Type 2 diabetes patients with microalbuminuria and macroalbuminuria display differential EV profiles. miR-99a-5p expression is elevated in EVs from macroalbuminuria and mTOR is its validated mRNA target.
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Affiliation(s)
- Melissa Uil
- Department of Pathology, Amsterdam Infection & Immunity Institute, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Chi M Hau
- Laboratory of Experimental Clinical Chemistry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Vesicle Observation Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mohamed Ahdi
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - James D Mills
- Department of Pathology, Amsterdam Infection & Immunity Institute, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jesper Kers
- Department of Pathology, Amsterdam Infection & Immunity Institute, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Van’t Hoff Institute for Molecular Sciences (HIMS), University of Amsterdam, Amsterdam, The Netherlands
| | - Moin A Saleem
- Academic Renal Unit, University of Bristol, Southmead Hospital, Bristol, UK
| | - Sandrine Florquin
- Department of Pathology, Amsterdam Infection & Immunity Institute, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Victor E A Gerdes
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Rienk Nieuwland
- Laboratory of Experimental Clinical Chemistry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Vesicle Observation Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Joris J T H Roelofs
- Department of Pathology, Amsterdam Infection & Immunity Institute, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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14
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Akenine U, Barbera M, Beishuizen CR, Fallah Pour M, Guillemont J, Rosenberg A, Coley N, Mangialasche F, Salo L, Savy S, Pols AJ, Andrieu S, Richard E, Soininen H, Moll van Charante E, Kivipelto M. Attitudes of at-risk older adults about prevention of cardiovascular disease and dementia using eHealth: a qualitative study in a European context. BMJ Open 2020; 10:e037050. [PMID: 32764085 PMCID: PMC7412614 DOI: 10.1136/bmjopen-2020-037050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/27/2020] [Accepted: 06/11/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Prevention of cardiovascular disease (CVD) and dementia is a key health priority among older adults. Understanding individuals' attitudes to, the prevention of these conditions, particularly when delivered through novel eHealth tools, could help in designing effective prevention programmes. The aim of the study was to explore the attitudes of older adults at increased risk of CVD and dementia regarding engagement in eHealth self-management prevention programmes, and to describe the facilitators and barriers. DESIGN A qualitative research approach was used. Data were collected through eight focus groups in Finland, France and the Netherlands. Data were analysed following the principles of grounded theory. SETTING AND PARTICIPANTS Forty-four community-dwellers aged 65+ at risk of CVD were recruited from a previous trial cohort in Finland, and through general practices in France and the Netherlands. RESULTS The study identified three categories: access to reliable information, trust in the healthcare providers and burden and stigma of dementia. A core category was also identified: the interactive process of the three categories influencing engagement in self-management prevention programme. The categories were interconnected through an interactive process and influenced by the local healthcare culture and context which shaped them differently, becoming either facilitators or barriers to engage in eHealth self-management prevention programmes. CONCLUSIONS The study emphasises the importance of considering the interactions between the identified categories in this study, grounded in the local healthcare culture and context in further developments of eHealth self-management interventions that aim to prevent CVD and dementia. TRIAL REGISTRATION NUMBER ISRCTN48151589.
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Affiliation(s)
- Ulrika Akenine
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Mariagnese Barbera
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, Kuopio, Finland
| | - Cathrien Rl Beishuizen
- Department of General Practice, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
| | - Mandana Fallah Pour
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | - Anna Rosenberg
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, Kuopio, Finland
| | - Nicola Coley
- INSERM, University of Toulouse, Toulouse, France
- Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | - Francesca Mangialasche
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Lotta Salo
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, Kuopio, Finland
| | | | - A Jeannette Pols
- Section of Medical Ethics, Department of General Practice, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
| | - Sandrine Andrieu
- INSERM, University of Toulouse, Toulouse, France
- Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | - Edo Richard
- Department of Neurology, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hilkka Soininen
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, Kuopio, Finland
- Neurocenter Finland, Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Eric Moll van Charante
- Department of General Practice, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Aging, Karolinska University Hospital, Stockholm, Sweden
- R&D Unit, Stockholms Sjukhem, Stockholm, Sweden
- Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, United Kingdom
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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15
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Vreemann S, Gubern-Merida A, Lardenoije S, Bult P, Karssemeijer N, Pinker K, Mann RM. The frequency of missed breast cancers in women participating in a high-risk MRI screening program. Breast Cancer Res Treat 2018; 169:323-331. [PMID: 29383629 PMCID: PMC5945731 DOI: 10.1007/s10549-018-4688-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 01/21/2018] [Indexed: 12/19/2022]
Abstract
Purpose To evaluate the frequency of missed cancers on breast MRI in women participating in a high-risk screening program. Methods Patient files from women who participated in an increased risk mammography and MRI screening program (2003–2014) were coupled to the Dutch National Cancer Registry. For each cancer detected, we determined whether an MRI scan was available (0–24 months before cancer detection), which was reported to be negative. These negative MRI scans were in consensus re-evaluated by two dedicated breast radiologists, with knowledge of the cancer location. Cancers were scored as invisible, minimal sign, or visible. Additionally, BI-RADS scores, background parenchymal enhancement, and image quality (IQ; perfect, sufficient, bad) were determined. Results were stratified by detection mode (mammography, MRI, interval cancers, or cancers in prophylactic mastectomies) and patient characteristics (presence of BRCA mutation, age, menopausal state). Results Negative prior MRI scans were available for 131 breast cancers. Overall 31% of cancers were visible at the initially negative MRI scan and 34% of cancers showed a minimal sign. The presence of a BRCA mutation strongly reduced the likelihood of visible findings in the last negative MRI (19 vs. 46%, P < 0.001). Less than perfect IQ increased the likelihood of visible findings and minimal signs in the negative MRI (P = 0.021). Conclusion This study shows that almost one-third of cancers detected in a high-risk screening program are already visible at the last negative MRI scan, and even more in women without BRCA mutations. Regular auditing and double reading for breast MRI screening is warranted.
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Affiliation(s)
- S. Vreemann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
| | - A. Gubern-Merida
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
| | - S. Lardenoije
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
| | - P. Bult
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - N. Karssemeijer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
| | - K. Pinker
- Division of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University Vienna, Vienna, Austria
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - R. M. Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
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Schuiringa H, van Nieuwenhuijzen M, Orobio de Castro B, Lochman JE, Matthys W. Effectiveness of an Intervention for Children with Externalizing Behavior and Mild to Borderline Intellectual Disabilities: A Randomized Trial. Cognit Ther Res 2016; 41:237-251. [PMID: 28344370 PMCID: PMC5346153 DOI: 10.1007/s10608-016-9815-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study evaluated the effectiveness of Standing Strong Together (SST), a combined group based parent and child intervention for externalizing behavior in 9-16 year-old children with mild to borderline intellectual disabilities (MBID). Children with externalizing behavior and MBID (IQ from 55 to 85) (N = 169) were cluster randomly assigned to SST combined with care as usual or to care as usual only. SST led to a significant benefit on teacher reported but not on parent reported externalizing behavior. SST had significant effects on parent rated positive parenting and the parent-child relationship. The present study shows that a multicomponent group based intervention for children with MBID is feasible and has the potential to reduce children's externalizing behavior and improve both parenting behavior and the parent-child relationship.
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Affiliation(s)
- Hilde Schuiringa
- Department of Developmental Psychology, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, The Netherlands
| | - Maroesjka van Nieuwenhuijzen
- Department of Clinical Child and Family Studies, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
- Learn Research Institute for Learning and Education, VU University Amsterdam, Amsterdam, The Netherlands
- The EMGO+ Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands
| | - Bram Orobio de Castro
- Department of Developmental Psychology, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, The Netherlands
| | - John E. Lochman
- Department of Clinical Psychology, University of Alabama, Tuscaloosa, AL USA
- The Conduct Disorder Prevention Research Group, University of Alabama, Tuscaloosa, AL USA
| | - Walter Matthys
- Department of Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands
- Department of Psychiatry of University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Nicolaou M, Gademan MGJ, Snijder MB, Engelbert RHH, Dijkshoorn H, Terwee CB, Stronks K. Validation of the SQUASH Physical Activity Questionnaire in a Multi-Ethnic Population: The HELIUS Study. PLoS One 2016; 11:e0161066. [PMID: 27575490 PMCID: PMC5004804 DOI: 10.1371/journal.pone.0161066] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 07/30/2016] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To investigate the reliability and validity of the SQUASH physical activity (PA) questionnaire in a multi-ethnic population living in the Netherlands. METHODS We included participants from the HELIUS study, a population-based cohort study. In this study we included Dutch (n = 114), Turkish (n = 88), Moroccan (n = 74), South-Asian Surinamese (n = 98) and African Surinamese (n = 91) adults, aged 18-70 years. The SQUASH was self-administered twice to assess test-re-test reliability (mean interval 6-7 weeks) and participants wore an accelerometer and heart rate monitor (Actiheart) to enable assessment of construct validity. RESULTS We observed low test-re-test reliability; Intra class correlation coefficients ranged from low (0.05 for moderate/high intensity PA in African Surinamese women) to acceptable (0.78 for light intensity PA in Moroccan women). The discrepancy between self-reported and measured PA differed on the basis of the intensity of activity: self-reported light intensity PA was lower than measured but self-reported moderate/high intensity PA was higher than measured, with wide limits of agreement. The discrepancy between questionnaire and Actiheart measures of moderate intensity PA did not differ between ethnic minority and Dutch participants with correction for relevant confounders. Additionally, the SQUASH overestimated the number of participants meeting the Dutch PA norm; Cohen's kappas for the agreement were poor, the highest being 0.30 in Dutch women. CONCLUSION We found considerable variation in the test-re-test reliability and validity of self-reported PA with no consistency based on ethnic origin. Our findings imply that the SQUASH does not provide a valid basis for comparison of PA between ethnic groups.
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Affiliation(s)
- M. Nicolaou
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - M. G. J. Gademan
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - M. B. Snijder
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - R. H. H. Engelbert
- Education of Physical Therapy, Amsterdam School of Health Professions (ASHP), University of Applied Sciences, Amsterdam, The Netherlands
- Department of Rehabilitation, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - H. Dijkshoorn
- Department of Epidemiology and Health Promotion, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - C. B. Terwee
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - K. Stronks
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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